Midterm Patency after Off-Pump Coronary Artery Bypass Grafting

Lee, Cheul; Chang, Woo Ik; Lim, Cheong; Kim, Ki Bong; Chae, In Ho; Oh, Byung Hee; Lee, Myoung Mook; Park, Young Bae

Abstract

BACKGROUND: The aim of this study was to compare one-year graft patency after coronary artery bypass grafting without cardiopulmonary bypass(OPCAB) with that of conventional CABG and that of on-pump beating CABG, and to demonstrate any differences in patency of various conduits among the three groups. MATERIAL AND METHOD: We analyzed the results of OPCAB cases(group I; n=122) compared with those of conventional CABG cases(group II; n=65) and those of on-pump beating CABG cases(group III; n=19). In group I, coronary angiography(CAG) was performed immediately postoperatively and 1 year after surgery. In groups II and III, CAG was performed 1 year after surgery. Graft patency was graded as grade A(excellent), grade B(fair), or grade O(occluded). RESULT: The average number of distal anastomoses in groups I, II, and III were 3.1+/-1.1, 3.7+/-0.9, and 3.6+/-0.9, respectively. In group I, postoperative CAG was performed in 92%(112/122) of patients before discharge. The patency rate(grade A+B) was 96.4%(162/168) for arterial grafts, and 85.6%(160/187) for saphenous vein grafts(SVG). One-year follow-up CAG was performed in 74%(90/122) of patients. The patency rate was 97.8%(132/135) for arterial grafts, and 67.9%(106/156) for SVG. In group II, one-year follow-up CAG was performed in 65%(42/65) of patients. The patency rate(grade A+B) was 93.5%(43/46) for arterial grafts, and 88.3%(98/111) for SVG. In group III, one-year follow-up CAG was performed in 89%(17/19) of patients. The patency rate(grade A+B) was 100%(19/19) for arterial grafts, and 86.8%(33/38) for SVG.
CONCLUSION
Our results demonstrated that the patency rate of SVG after OPCAB was significantly lower than that of arterial grafts in the early postoperative CAG(p<0.001), and was also significantly lower than those of SVG of group II(p<0.001) and group III(p<0.01) in the postoperative one-year CAG, although there was no ignificant difference in one-year patency of arterial grafts among the three groups. Our data suggest that a specific perioperative anticoagulant therapy may be advisable in patients undergoing OPCAB with SVG.